Gino Kenny Questions 'Unregulated' Mental Health Services

Deputy Kenney I have two specific questions. The first question is in relation to the submission by the Mental Health Commission. So if you look at the first page, Section 2, it says Mental Health Services Regulation. I wonder could a spokesperson for the Commission define the use of unregulated. So I'll just read the paragraph. A fourth or 10% are delivered within specialist mental health services, including a 24-hour nursing staff community residency, which are unregulated. So could they define what unregulated is, please? So under the Mental Health Act, we register and we monitor and we can take action in terms of approved centres. So they're the inpatient centres that are registered and we have powers around that. In relation to all other mental health services, the inspector has the power to visit, but we don't have powers to make them be of how they should be. So some of the hostels, for example, that people are in or the community houses, they're really not fit for purpose and that came across in COVID. So, for example, you could be sharing a room with three other people that you don't know, not family members. And I don't think anyone else in society, unless you have a really big family, kind of does that. So there's that element. And the other thing is that the community, the primary care services. So if your child is unwell or you're unwell, you go to your GP or you go to A&E and then you kind of get into the, if you need to, the idea is that you can go to kind of secondary services before you go to the final 1% of services. And the idea, as Mr. Ryan was saying, is tiered, that you see people as early as possible in their communities. So, for example, if you think of Clondoggan, you know, you're not going to Tala Hospital. The services are in Rola or in Neilstown or in Palmerstown and you're met there or in your home. We don't regulate any of that. And in a way, it's kind of unfair on the acute units, because what you see with the acute units is, because we have a strong light shining on them and a very strong light shining on them, there's a huge transparency. You see all the issues. But in fact, they're really, that's caused by not having potentially any scrutiny of the services out in the community and they're not regulated. And can I ask, why are they not regulated and who runs these services? Well, in law, it's the Mental Health Act, hopefully, is going to be changed to allow us to move out a bit more. I'm very interested in the vulnerable people. And I know that sounds, I don't mean to be paternalistic, but the people who are become unwell, who mightn't have the supports in society, who fall through the cracks. As far as I'm concerned as a public servant, my job is to make sure that those people are protected. And they number in the thousands, it's kind of 1%. The reason they're not regulated is, is that the government policy is that they're not regulated. OK, just the last question in relation to, I suppose, for the HSE. And I spoke earlier on the last session about the kind of, I suppose, the highs and lows of the public health emergency. And the highs were the kind of coming together of people, the solidarity and support that people showed with each other. And that was the bonding that, you know, people showed over them four months. And, you know, you can't buy that in some ways. But there was also huge lows, huge lows to many people that have to self-isolate and not been in that gathering of, because we're social animals at the end of the day. And the loss of that has been incalculable. What has been the long, the lasting effect on, in some ways, the natural psyche, but also to the individual of the last four and a half months in relation to, you know, the issues of depression, anxiety and so forth. But what is the lasting effect on individuals and the population? So, part of the challenges at the moment, we're not sure. Obviously, from research, we've seen what has happened in previous traumatic situations. But COVID, considering it's with us, will be with us for a considerable period of time, poses a greater challenge. I'm a member of the IIMHL, the International Institute of Mental Health Leadership. And our international colleagues have done a lot of work on what are the medium-term effects. And the concern initially is that, as you say, there's a sort of a buzz about people coming together. And then there's a flatter period. One of the things that we need to try and ensure, though, is that from a primary care and universal support, as I was mentioning earlier, and our tiered level of support, is that we don't ensure, we don't, we don't say that everybody who is feeling down has a mental illness, because that isn't the case. We need to ensure that our secondary care and tertiary care services for those who need it most. But from the point of view of the more primary care, one of the things we've attempted to do is to use technology, whether it is SilverCloud or MyMinds, but now turn to me, any number of other organisations that we have funded in order to deliver additional counselling services and counselling sessions, which can be delivered online. Because we do think that it's about giving people the tools in order to be able to deal with what we hope will be a finite issue, but one in which we now recognise is going to be with us for a period of time. So we want to try and invite, we want to try and make sure of two things. One is that we provide upfront services, but that also we make sure that the services that are required for those who have a longer-term mental illness are not adversely affected either.